AB1331 DIAGNOSTIC CAPABILITY OF ANESTHETIC INTRA-ARTICULAR INJECTIONS FOR FEMOROACETABULAR IMPINGEMENT
Authors: E. Campos Martins, D. Araujo Fernandes, G. Melo, F. De Souza Neves
Journal: Annals of the Rheumatic Diseases (2022)

Background Femoroacetabular impingement syndrome (FAIS) is a highly prevalent painful disorder that is considered a risk factor for hip osteoarthritis. Confirming that FAIS is the main cause of a pain is a hard task. There are patients who have the typical morphological alterations of FAIS, but are asymptomatic. FAIS morphologies can represent a major confounding factor in patients with undiagnosed rheumatic diseases. On the other hand, surgery can significantly improve quality of life of patients with FAIS. Anesthetic intra-articular injections might constitute viable alternatives for diagnosing FAIS. Objectives This systematic review aimed to answer the following question: “What is the diagnostic capability of anesthetic intra-articular hip injections for the assessment of FAIS?”. Methods This study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Embase, CINAHL, LILACS, PubMed, SCOPUS, SPORTDiscuss, The Cochrane Library, and Web of Science databases were screened. All studies that assessed the diagnostic capability of anesthetic intra-articular hip injections for the assessment of FAIS were considered eligible. Study selection and data collection were performed by three independent reviewers. Risk of bias of the included studies was assessed through the QUADAS-2 tool. Results A total of 13 articles were selected for full-text reading, of which 5 were finally considered eligible and included for analysis [1-5]. A summary of the studies’ descriptive characteristics can be found in the Table 1. Overall judgment was “at risk of bias” for all included studies (Figure 1). More detailed information regarding bias assessment at QUADAS-2 is available in the Figure 1. From 5 included studies, only 2 [2,5] indicated that anesthetic intra-articular injections can be useful as diagnostic tools for FAIS. Figure 1. Table 1. Author Mean Age N (Female ) Injection Content Injection Guidance Time for pain assessment after injection (Way of assessment ) Threshold to consider FAIS diagnosis Reference Standard Findings Kivlan 29.9 ± 10.4 72 (54) Lidocaine + bupivacaine + triamcinolone Fluoroscopy 2 hours (provocative activities) Not established Arthroscopy No difference in pain relief after injection between individuals with and without FAIS (p=0.128) Kraeutler 38.8 ± 14.2 161 (120) Lidocaine + triamcinolone Non-guided 10 minutes (physical tests and provocative activities) &gt;70% of pain relief after injection Symptoms + physical tests + radiography FAIS and dysplasia diagnosed in 76% of patients with &gt;70% of pain relief after injection, and in 67% in patients presenting &lt;70% (p=0.62) Chinzei 36.7 ± 14.7 49 (27) Lidocaine Fluoroscopy 2 weeks (uninformed) &gt;50% of pain relief Arthroscopy No significant association between pain relief intensity after injection and the presence of FAIS (p&gt;0.05) Gao 36 (16-65) 78 (41) Lidocaine + betamethasone Ultrasound 10 minutes and 1 week (routine tasks) &gt; 50% of pain relief Arthroscopy Response to injection is 91.7% accurate for detecting FAIS Perdikakis 33 (18-58) 34 (20) Ropivacaine Fluoroscopy 30 minutes (physical tests) Uninformed Arthroscopy Response to injection presented 92% of PPV and 96,5% of accuracy for diagnosing FAIS, with NPV and sensitivity of 100% Conclusion Evidence regarding the diagnostic capability of anesthetic intra-articular hip injections for FAIS is sparse. In order to accurately answer our research question, future studies that use standardized and optimized protocols of injection and pain assessment after injection are still essential. Furthermore, the need to take into account the different biases surrounding diagnostic studies was highlighted in our study. References [1]N Chinzei et al., Eur J Orthop Surg Traumatol 30 (4), 737 (2020) [2]G Gao et al., Arthroscopy 37 (1), 128 (2021) [3]BR Kivlan et al., Arthroscopy 27 (5), 619 (2011) [4]MJ Kraeutler et al., J Hip Preserv Surg 5 (3), 220 (2018) [5]E Perdikakis et al., Hell J Radiol 6 (2), 6 (2021) Disclosure of Interests None declared